Some people in recovery swear by the effectiveness of the drugs, but the FDA and many treatment experts say there is no credible evidence to support their use.
Arron Veysey credits marijuana, kratom and Roxanne Gullikson with helping him quit an opioid habit that was ruining his life.
“She basically saved my life,” said Veysey, 33, who works as a prep cook at a Portland retirement home. “I’m able to get up and go to work every day, and have a life. I don’t look at marijuana as a drug anymore.
Veysey said when he was taking heroin, he was in and out of jail for various drug-related crimes, “homeless and miserable. I didn’t want anyone else around. I was always chasing the drug.”
Marijuana is calming and soothing, and helps him stay focused and get through each day, Veysey said. He said he has joined a church and repaired relationships with family members.
On March 1, Gullikson and her husband, Ron Figaratto, are opening Greener Pastures, a controversial residential treatment home in Portland. At a cost of $20,000 per month per patient, it will promote cannabis use for long-term treatment for opioid addiction and kratom for withdrawal from the powerful painkillers.
Kratom is a tropical evergreen that is dried and crushed into tiny leaves or a powder that people can purchase, often from online retailers. It is legal, but not approved by the Food and Drug Administration for any medical use. The federal government has import restrictions on kratom, and has been seizing some deliveries of the drug when it enters the U.S.
Critics say there’s no proof that any of it – marijuana or kratom – works for addiction treatment.
Gullikson has run an outpatient program for about four years that uses marijuana and kratom to try to help those suffering from opioid addiction. The new 12-bed program, which will open within the next few months, will be for women only and will have an average stay of about 90 days.
Some of the foremost addiction experts in Maine and the nation, however, said Gullikson is peddling a dubious course of treatment that isn’t proven and could be dangerous. Recovery homes, which are largely unregulated, have also come under increasing scrutiny for charging exorbitant fees while having sketchy standards. There haven’t been any documented cases of recovery homes ripping people off in Maine, but other states, such as Florida and New York, have reported that some of the homes have operated in unscrupulous ways.
Mark Parrino, president of the New York-based American Association for the Treatment of Opioid Dependence, said such operations are “suspect” because there are no studies that support using marijuana and kratom for opioid use disorder.
“When there’s no scientific research, then it becomes, ‘This is my personal point of view and I can make some money here,’ ” Parrino said.
Gullikson said Greener Pastures, as far as she knows, will be the first marijuana- and kratom-based residential treatment center in Maine. She said she’s not sure how insurance companies are going to reimburse for her services, but they will work with patients. They will try to take Medicaid patients as well, and the plan is to eventually offer two “scholarship” beds where patients do not have to pay. Gullikson said she realizes the out-of-pocket costs are hefty and unaffordable for most. It’s unclear how much of the treatment insurance companies will cover.
‘BELIEF IS NOT PROOF OF EFFECTIVENESS’
Dr. Mark Publicker, a Portland-based addiction treatment specialist, said touting marijuana and kratom to treat addictions is not evidence-based, gives people false hope and is “harmful nonsense.” While kratom is a legal product, the FDA has issued warnings about overdose risks and other dangers.
“There is absolutely no research or evidence that kratom has positive effects. Someone’s belief is not proof of a treatment’s effectiveness,” Publicker said. “Many if not most people addicted to opiates, and those in recovery from opiate addiction, smoke cannabis. If it were effective there would be tens of thousands less so addicted.”
Because recovery homes are largely unregulated, it’s difficult to say how many there are in Maine. However, there are 350 beds for residential substance abuse treatment, according to the Maine Department of Health and Human Services. There are 7,000 slots for outpatient medication-assisted treatment programs, the agency says.
Publicker said if the idea catches on that marijuana can cure opioid addiction, it could set back public policy efforts to try to alleviate the public health crisis. There’s a long-shot effort in the Maine Legislature to designate addiction as a qualifying condition for medical marijuana, sponsored by Sen. Eric Brakey, R-Auburn. Marijuana is also legal in Maine for recreational use, although federal law still bans the drug.
The “gold standard” evidence-based treatment involves medication-assisted treatment combined with counseling, which research has shown has the best outcomes for patients.
“If someone wanted to promote cannabis as an effective treatment for poison ivy, it wouldn’t result in significant harm, even though more effective treatment is available,” Publicker said “But 50,000 people died of drug overdoses last year, so many that the country’s life expectancy actually lowered two years in a row. We have three medications with unequivocal evidence for their effectiveness in saving lives. We’re talking about deaths, not rashes. This is harmful nonsense.”
The medications Publicker is referring to are Suboxone, methadone and Vivitrol. All of the medications work to curb cravings in the brain caused by opioid use.
But Gullikson, despite the criticism, is forging ahead with Greener Pastures, the residential treatment home for women, plus she will continue outpatient programs for both men and women.
“Now there’s this embrace of all routes to recovery. There’s been a loss of stigma for these methods,” Gullikson said.
LACK OF RESEARCH ‘FRUSTRATING’
Gullikson proudly displays a poster board in her home with green X’s, testimonials from people who say cannabis helped them beat their opioid addictions. The X’s represent cannabis use, while they cross out common opioid pills, such as oxycodone and hydrocodone.
Maine is undergoing an opioid epidemic, with 376 drug overdose deaths in 2016, an all-time high, and 185 overdose deaths through the first half of 2017, the latest statistics available.
Drug overdose deaths now exceed car accidents in deaths caused per year.
Gullikson said marijuana is a far less harmful substance than opioids, and it would be better for society if more people switched from opioids to cannabis. Some formulations of cannabis that have high cannabidiol, or CBD, properties and low or zero amounts of THC, which causes the “head high,” can mean that many patients do not get a high at all from taking the products.
Patients can take medical marijuana not just by smoking it, but in a number of other ways, such as using oils, tinctures or edibles.
Gullikson acknowledged that there’s a lack of research that’s been conducted in the United States on cannabis and treating medical conditions, but she said that is the fault of the FDA, which puts many roadblocks in the way of research by misclassifying marijuana as a Schedule I drug. Researchers are mostly prohibited from using human-based testing for Schedule I drugs because they are considered harmful and the testing would run afoul of medical ethics standards.
“It’s frustrating that there isn’t more research. But we’re seeing community-based evidence time and time again that this is working,” said Gullikson, who plans to track patient outcomes at her residential recovery home.
Gullikson pointed to research done in Israel regarding marijuana and addiction, and she has a medical director, Sanford-based Dr. Mary Callison, who also touted overseas research that was done in Malaysia on using kratom for opioid withdrawal.
Publicker said those studies are thin, and much more rigorous testing and research would need to be conducted before it could be determined whether both products had any medical value.
Callison said she has seen “dozens of times” how marijuana and kratom have helped people beat opioid addictions. Callison said some early research is showing that cannabis and kratom work.
She said there will always be naysayers, attached to preserving the status quo.
“Everyone has their script and they read from it. It’s much easier for people to just say what other people are saying rather than looking for themselves,” said Callison, who operates a mobile and telemedicine business called Budding Potentials where she prescribes cannabis for patients. Her website hawks Budding Potentials mugs, T-shirts and carry bags that aren’t for sale yet, but are advertised as being available soon.
KRATOM MAY ‘MAKE THINGS WORSE’
Marc Colello, 42, of Auburn said he was a patient of Gullikson, and medical marijuana and kratom helped him beat opioid addictions that lasted nearly 20 years.
“If you say you’re going to use cannabis for addiction treatment, people are initially like, ‘Ha, ha, yeah right.’ But it’s happening. People are doing this, and it’s working,” said Colello, a self-employed IT contractor. “I have a life, a job, friends and activities. I had no quality of life before.”
Dr. Mary Dowd, who counsels people with opioid addictions at Catholic Charities and is the medical director at Milestone Recovery in Portland’s detox center, said there’s no evidence marijuana works for opioid addictions, and she has seen kratom more at the detox center.
“I have seen people use it to withdraw off of heroin, but then they are addicted to kratom and have to withdraw from kratom,” Dowd said.
Dr. Karen Simone, director of the Northern New England Poison Control Center, said kratom is not the worst drug that people are abusing, and it would be extremely rare for someone to die of a kratom drug overdose, but she doesn’t view it as helpful in the opioid crisis. There were 16 kratom-related calls to the poison control center in 2017, up from four in 2016. Mostly, people are using kratom to get high, Simone said.
“I don’t see kratom as a solution to the (opioid) problem and it may in some cases make things worse for some patients,” Simone said.
The FDA commissioner, Dr. Scott Gottlieb, issued a written warning about kratom in November, saying claims of healing powers are dubious.
“The FDA knows people are using kratom to treat conditions like pain, anxiety and depression, which are serious medical conditions that require proper diagnosis and oversight from a licensed health care provider. We also know that this substance is being actively marketed and distributed for these purposes. Importantly, evidence shows that kratom has similar effects to narcotics like opioids, and carries similar risks of abuse, addiction and in some cases, death. Thus, it’s not surprising that often kratom is taken recreationally by users for its euphoric effects. At a time when we have hit a critical point in the opioid epidemic, the increasing use of kratom as an alternative or adjunct to opioid use is extremely concerning,” Gottlieb wrote.
‘ABSTINENCE CAN BE SUCCESSFUL’
Dr. Noah Nesin, vice president of the Penobscot Community Health Center in Bangor, said there is limited research that indicates marijuana may help in some cases of chronic pain, but none for addiction treatment. He said people can be beating their addictions through counseling and changes to lifestyle and crediting marijuana, but the marijuana didn’t actually help them. He said it’s similar to how some people can abstain from opioids and be successful in recovery, although medication-assisted treatment has been proven to be far more effective.
“For some individuals abstinence can be successful,” Nesin said. “The best outcomes are to use medication-assisted treatment, using Suboxone and methadone combined with individual and group counseling.”
Colello said he went to a methadone clinic for years, and it didn’t help him. He would supplement the methadone with heroin, and he said he never felt that methadone was really treating his problem.
But Colello said 15 months ago, his girlfriend died of a drug overdose at his apartment, and he spent 30 days in jail on a charge of furnishing her the drugs.
“When I got out of jail, I took three steps toward the methadone clinic and then just stopped and said, ‘I can’t do this anymore,’ ” Colello said. He said he used kratom for withdrawal and marijuana, and with Gullikson’s help has been clean ever since. “She was right there with me, every step of the way, in my recovery. It’s a revelation.”